Applications of ultrasound elastography to hand and upper limb disorders

Ultrasound elastography is a recently developed method for accurate measurement of soft tissue stiffness in addition to the clinician's subjective evaluation. The present review briefly describes the ultrasound elastography techniques and outlines clinical applications for tendon, muscle, nerve, skin and other soft tissues of the hand and upper limb. Strain elastography provides a qualitative evaluation of the stiffness, and shear-wave elastography generates quantitative elastograms superimposed on a B-mode image. The stiffness in degenerative tendinopathy and/or tendon injury was significantly lower than in a normal tendon in several studies. Elastography is also a reliable method to evaluate functional muscle activity, compared to conventional surface electromyography. The median nerve is consistently stiffer in patients with carpal tunnel syndrome than in healthy subjects, on whatever ultrasound elastography technique. Elastography distinguishes normal skin from scars and can be used to evaluate scar severity and treatment. Elastography has huge clinical applications in musculoskeletal tissues. Continued development of systems and increased training of clinicians will expand our knowledge of elastography and its clinical applications in the future.

Multiscale analysis of Klf10's impact on the passive mechanical properties of murine skeletal muscle

Skeletal muscle is a hierarchical structure composed of multiple organizational scales. A major challenge in the biomechanical evaluation of muscle relates to the difficulty in evaluating the experimental mechanical properties at the different organizational levels of the same tissue. Indeed, the ability to integrate mechanical properties evaluated at various levels will allow for improved assessment of the entire tissue, leading to a better understanding of how changes at each level evolve over time and/or impact tissue function, especially in the case of muscle diseases. Therefore, the purpose of this study was to analyze a genetically engineered mouse model (Klf10 KO: Krüppel-Like Factor 10 knockout) with known skeletal muscle defects to compare the mechanical properties with wild-type (WT) controls at the three main muscle scales: the macroscopic (whole muscle), microscopic (fiber) and submicron (myofibril) levels. Passive mechanical tests (ramp, relaxation) were performed on two types of skeletal muscle (soleus and extensor digitorum longus (EDL)). Results of the present study revealed muscle-type specific behaviors in both genotypes only at the microscopic scale. Interestingly, loss of Klf10 expression resulted in increased passive properties in the soleus but decreased passive properties in the EDL compared to WT controls. At the submicron scale, no changes were observed between WT and Klf10 KO myofibrils for either muscle; these results demonstrate that the passive property differences observed at the microscopic scale (fiber) are not caused by sarcomere intrinsic alterations but instead must originate outside the sarcomeres, likely in the collagen-based extracellular matrix. The macroscopic scale revealed similar passive mechanical properties between WT and Klf10 KO hindlimb muscles. The present study has allowed for a better understanding of the role of Klf10 on the passive mechanical properties of skeletal muscle and has provided reference data to the literature which could be used by the community for muscle multiscale modeling.

Deciphering the Role of Klf10 in the Cerebellum

Recent studies have demonstrated a new role for Klf10, a Krüppel-like transcription factor, in skeletal muscle, specifically relating to mitochondrial function. Thus, it was of interest to analyze additional tissues that are highly reliant on optimal mitochondrial function such as the cerebellum and to decipher the role of Klf10 in the functional and structural properties of this brain region. In vivo (magnetic resonance imaging and localized spectroscopy, behavior analysis) and in vitro (histology, spectroscopy analysis, enzymatic activity) techniques were applied to comprehensively assess the cerebellum of wild type (WT) and Klf10 knockout (KO) mice. Histology analysis and assessment of locomotion revealed no significant difference in Klf10 KO mice. Diffusion and texture results obtained using MRI revealed structural changes in KO mice characterized as defects in the organization of axons. These modifications may be explained by differences in the levels of specific metabolites (myo-inositol, lactate) within the KO cerebellum. Loss of Klf10 expression also led to changes in mitochondrial activity as reflected by a significant increase in the activity of citrate synthase, complexes I and IV. In summary, this study has provided evidence that Klf10 plays an important role in energy production and mitochondrial function in the cerebellum.

Improved Ultrasound Attenuation Measurement Method for the Non-invasive Evaluation of Hepatic Steatosis Using FibroScan

Controlled attenuation parameter (CAP) is a measurement of ultrasound attenuation used to assess liver steatosis non-invasively. However, the standard method has some limitations. This study assessed the performance of a new CAP method by ex vivo and in vivo assessments. The major difference with the new method is that it uses ultrasound data continuously acquired during the imaging phase of the FibroScan examination. Seven reference tissue-mimicking phantoms were used to test the performance. In vivo performance was assessed in two cohorts (in total 195 patients) of patients using magnetic resonance imaging proton density fat fraction (MRI-PDFF) as a reference. The precision of CAP was improved by more than 50% on tissue-mimicking phantoms and 22%-41% in the in vivo cohort studies. The agreement between both methods was excellent, and the correlation between CAP and MRI-PDFF improved in both studies (0.71 to 0.74; 0.70 to 0.76). Using MRI-PDFF as a reference, the diagnostic performance of the new method was at least equal or superior (area under the receiver operating curve 0.889-0.900, 0.835-0.873). This study suggests that the new continuous CAP method can significantly improve the precision of CAP measurements ex vivo and in vivo.

Krüppel-like factor 10 regulates the contractile properties of skeletal muscle fibers in mice

INTRODUCTION/AIMS

Klf10 is a member of the Krüppel-like family of transcription factors, which is implicated in mediating muscle structure (fiber size, organization of the sarcomere), muscle metabolic activity (respiratory chain), and passive force. The aim of this study was to further characterize the roles of Klf10 in the contractile properties of skeletal muscle fibers.

METHODS

Fifty-two single fibers were extracted from female wild-type (WT) and Klf10 knockout (KO) oxidative (soleus) and glycolytic (extensor digitorum longus [EDL]) skinned muscles. Each fiber was immersed successively in relaxing (R), washing (W), and activating (A) solutions. Calcium was included in the activating solution to induce a maximum contraction of the fiber. The maximum force (F_max ) was measured and normalized to the cross-sectional area to obtain the maximum stress (Stress_max ). After a steady state in contraction was reached, a quick stretch-release was performed; the force at the maximum stretch (F_stretch ) was measured and the stiffness was assessed.

RESULTS

Deletion of the Klf10 gene induced changes in the contractile parameters (F_max , Stress_max , Stiffness), which were lower and higher for soleus and EDL fibers compared with littermates, respectively. These measurements also revealed changes in the proportion and resistance of attached cross-bridges.

DISCUSSION

Klf10 plays a major role in the homeostasis of the contractile behavior of skeletal muscle fibers in a muscle fiber type-specific manner. These findings further implicate important roles for Klf10 in skeletal muscle function and shed new light on understanding the molecular processes regulating the contractility of skeletal muscle fibers.

Novel role of Tieg1 in muscle metabolism and mitochondrial oxidative capacities

AIM

Tieg1 is involved in multiple signalling pathways, human diseases, and is highly expressed in muscle where its functions are poorly understood.

METHODS

We have utilized Tieg1 knockout (KO) mice to identify novel and important roles for this transcription factor in regulating muscle ultrastructure, metabolism and mitochondrial functions in the soleus and extensor digitorum longus (EDL) muscles. RNA sequencing, immunoblotting, transmission electron microscopy, MRI, NMR, histochemical and mitochondrial function assays were performed.

RESULTS

Loss of Tieg1 expression resulted in altered sarcomere organization and a significant decrease in mitochondrial number. Histochemical analyses demonstrated an absence of succinate dehydrogenase staining and a decrease in cytochrome c oxidase (COX) enzyme activity in KO soleus with similar, but diminished, effects in the EDL. Decreased complex I, COX and citrate synthase (CS) activities were detected in the soleus muscle of KO mice indicating altered mitochondrial function. Complex I activity was also diminished in KO EDL. Significant decreases in CS and respiratory chain complex activities were identified in KO soleus. ¹ H-NMR spectra revealed no significant metabolic difference between wild-type and KO muscles. However, ³¹ P spectra revealed a significant decrease in phosphocreatine and ATPγ. Altered expression of 279 genes, many of which play roles in mitochondrial and muscle function, were identified in KO soleus muscle. Ultimately, all of these changes resulted in an exercise intolerance phenotype in Tieg1 KO mice.

CONCLUSION

Our findings have implicated novel roles for Tieg1 in muscle including regulation of gene expression, metabolic activity and organization of tissue ultrastructure. This muscle phenotype resembles diseases associated with exercise intolerance and myopathies of unknown consequence.

The Effect of Freezing Time on Muscle Fiber Mechanical Properties

The purpose of this study was to investigate the effect of freezing time on the functional behavior of mouse muscle fibers. Passive mechanical tests were performed on single soleus muscle fibers from fresh (0 month) and preserved (stored at -20°C for 3, 6, 9 and 12 months) 3 month old mice. The Young's modulus and the dynamic and the static stresses were measured. A viscoelastic Hill model of 3rd order was used to fit the experimental relaxation test data. The statistical analysis corresponding to the elastic modulus of single muscle fibers did not differ when comparing fresh and stored samples for 3 and 6 months at -20 °C. From 9 months, fibers were less resistant and the mechanical properties were damaged. The primary goal of this study was to complete the gold standard process of muscle fiber preservation for subsequent mechanical property studies. We have demonstrated that muscle fibers can be stored at -20°C for up to 6 months without altering their mechanical properties.

Impact of TIEG1 on the structural properties of fast- and slow-twitch skeletal muscle

INTRODUCTION

Transforming growth factor-beta (TGF-β)-inducible early gene-1 (TIEG1) is a transcription factor that is highly expressed in skeletal muscle. The purpose of this study was to characterize the structural properties of both fast-twitch (EDL) and slow-twitch (soleus) muscles in the hindlimb of TIEG1-deficient (TIEG1^-/- ) mice.

METHODS

Ten slow and 10 fast muscles were analyzed from TIEG1^-/- and wild-type (WT) mice using MRI texture (MRI-TA) and histological analyses.

RESULTS

MRI-TA could discriminate between WT slow and fast muscles. Deletion of the TIEG1 gene led to changes in the texture profile within both muscle types. Specifically, muscle isolated from TIEG1^-/- mice displayed hypertrophy, hyperplasia, and a modification of fiber area distribution.

CONCLUSIONS

We demonstrated that TIEG1 plays an important role in the structural properties of skeletal muscle. This study further implicates important roles for TIEG1 in the development of skeletal muscle and suggests that defects in TIEG1 expression and/or function may be associated with muscle disease. Muscle Nerve 55: 410-416, 2017.

Impact of TIEG1 Deletion on the Passive Mechanical Properties of Fast and Slow Twitch Skeletal Muscles in Female Mice

As transforming growth factor (TGF)-β inducible early gene-1 is highly expressed in skeletal muscle, the effect of TIEG1 gene deletion on the passive mechanical properties of slow and fast twitch muscle fibers was analyzed. Twenty five muscle fibers were harvested from soleus (Sol) and extensor digitorum longus (EDL) muscles from TIEG1^-/^- (N = 5) and control (N = 5) mice. Mechanical tests were performed on fibers and the dynamic and static stresses were measured. A viscoelastic Hill model of 3rd order was used to fit the experimental relaxation test data. In parallel, immunohistochemical analyses were performed on three serial transverse sections to detect the myosin isoforms within the slow and fast muscles. The percentage and the mean cross sectional area of each fiber type were calculated. These tests revealed a significant increase in the mechanical stress properties for the TIEG1^-/^- Sol fibers while a significant decrease appeared for the TIEG1^-/^- EDL fibers. Hill model tracked the shape of the experimental relaxation curve for both genotypes and both fiber types. Immunohistochemical results showed hypertrophy of all fiber types for TIEG1^-/^- muscles with an increase in the percentage of glycolytic fibers (IIX, and IIB) and a decrease of oxidative fibers (I, and IIA). This study has provided new insights into the role of TIEG1, known as KLF10, in the functional (Sol_typeI: more resistant, EDL_typeIIB: less resistant) and morphological (glycolytic hypertrophy) properties of fast and slow twitch skeletal muscles. Further investigation at the cellular level will better reveal the role of the TIEG1 gene in skeletal muscle tissue.

Development of a phantom mimicking the functional and structural behaviors of the thigh muscles characterized with magnetic resonance elastography technique

Magnetic Resonance Elastography (MRE) is a non invasive technique based on the propagation of shear waves in soft tissues providing the quantification of the mechanical properties [1]. MRE was successfully applied to healthy and pathological muscles. However, the MRE muscle methods must be further improved to characterize the deep muscles. A way will be to develop phantom mimicking the muscle behavior in order to set up new MRE protocol. Thus, the purpose of this study is to create a phantom composed of a similar skeletal muscle architecture (fiber, aponorosis) and equivalent elastic properties as a function of the muscle state (passive or active). Two homogeneous phantoms were manufactured with different concentrations of plastisol to simulate the elastic properties in relaxed (50% of plastisol) and contracted (70% of plastisol) muscle conditions. Moreover, teflon tubing pipes (D = 0.9 mm) were thread in the upper part of the phantom (50%) to represent the muscle fibers and a plastic sheet (8 × 15 cm) was also included in the middle of the phantom to mimic the aponeurosis structure. Subsequently, MRE tests were performed with two different pneumatic drivers, tube and round, (f = 90Hz) to analyze the effect of the type of driver on the wave propagation. Then, the wavelength was measured from the phase images to obtain the elastic properties (shear modulus). Both phantoms revealed elastic properties which were in the same range as in vivo muscle in passive (μ(50%) = 2.40 ± 0.18 kPa ) and active (6.24 ± 0.21 kPa) states. The impact of the type of driver showed higher values (about 1.2kPa) with the tube. The analysis of the wave behavior revealed a sliding along the plastic sheet as it was observed for in vivo muscle study. The wave was also sensitive to the presence of the fibers where gaps were identified. The present study demonstrates the ability of the phantom to mimic the structural and functional properties of the muscle.

Use of digital image correlation and ultrasound: analysis of thigh muscle displacement fields

The understanding of the mechanical behavior of the muscle tissue is an important field of investigation with different applications in medicine, car crash and sport. Currently, few in vivo imaging techniques are able to characterize the mechanical properties of muscle. Thus, the development of an in vivo identification method is a current thematic where the displacement field measurements could be used for further interpretations. This study aims at presenting the displacement fields measured in the anterior, posterior, lateral and medial parts of the thigh muscles using ultrasound and Digital Image Correlation (DIC) techniques. The results of the displacement field measurements confirmed and are correlated with the ultrasound observations.

Quantifying the Elastic Property of Nine Thigh Muscles Using Magnetic Resonance Elastography

BACKGROUND

Pathologies of the muscles can manifest different physiological and functional changes. To adapt treatment, it is necessary to characterize the elastic property (shear modulus) of single muscles. Previous studies have used magnetic resonance elastography (MRE), a technique based on MRI technology, to analyze the mechanical behavior of healthy and pathological muscles. The purpose of this study was to develop protocols using MRE to determine the shear modulus of nine thigh muscles at rest.

METHODS

Twenty-nine healthy volunteers (mean age = 26 ± 3.41 years) with no muscle abnormalities underwent MRE tests (1.5 T MRI). Five MRE protocols were developed to quantify the shear moduli of the nine following thigh muscles at rest: rectus femoris (RF), vastus medialis (VM), vastus intermedius (VI), vastus lateralis (VL), sartorius (Sr), gracilis (Gr), semimembranosus (SM), semitendinosus (ST), and biceps (BC). In addition, the shear modulus of the subcutaneous adipose tissue was analyzed.

RESULTS

The gracilis, sartorius, and semitendinosus muscles revealed a significantly higher shear modulus (μ_Gr = 6.15 ± 0.45 kPa, μ_ Sr = 5.15 ± 0.19 kPa, and μ_ ST = 5.32 ± 0.10 kPa, respectively) compared to other tissues (from μ_ RF = 3.91 ± 0.16 kPa to μ_VI = 4.23 ± 0.25 kPa). Subcutaneous adipose tissue had the lowest value (μ_adipose tissue = 3.04 ± 0.12 kPa) of all the tissues tested.

CONCLUSION

The different elasticities measured between the tissues may be due to variations in the muscles' physiological and architectural compositions. Thus, the present protocol could be applied to injured muscles to identify their behavior of elastic property. Previous studies on muscle pathology found that quantification of the shear modulus could be used as a clinical protocol to identify pathological muscles and to follow-up effects of treatments and therapies. These data could also be used for modelling purposes.

Development of an Inverse Approach for the Characterization of In Vivo Mechanical Properties of the Lower Limb Muscles

The purpose of this study was to develop an inverse method, coupling imaging techniques with numerical methods, to identify the muscle mechanical behavior. A finite element model updating (FEMU) was developed in three main interdependent steps. First, a 2D FE modeling, parameterized by a Neo-Hookean behavior (C10 and D), was developed from a segmented thigh muscle 1.5T MRI (magnetic resonance imaging). Thus, a displacement field was simulated for different static loadings (contention, compression, and indentation). Subsequently, the optimal mechanical test was determined from a sensitivity analysis. Second, ultrasound parameters (gain, dynamic, and frequency) were optimized on the thigh muscles in order to apply the digital image correlation (DIC), allowing the measurement of an experimental displacement field. Third, an inverse method was developed to identify the Neo-Hookean parameters (C10 and D) by performing a minimization of the distance between the simulated and measured displacement fields. To replace the experimental data and to quantify the identification error, a numerical example was developed. The result of the sensitivity analysis showed that the compression test was more adapted to identify the Neo-Hookean parameters. Ultrasound images were recorded with a frequency, gain, and dynamic of 9 MHz, 34 dB, 42 dB, respectively. In addition, the experimental noise on displacement field measurement was estimated to be 0.2 mm. The identification performed on the numerical example revealed a low error for the C10 (<3%) and D (<7%) parameters with the experimental noise. This methodology could have an impact in the scientific and medical fields. A better knowledge of the muscle behavior will help to follow treatment and to ensure accurate medical procedures during the use of robotic devices.

ESTIMATION OF MUSCLE FORCE DERIVED FROM IN VIVO MR ELASTOGRAPHY TESTS: A PRELIMINARY STUDY

The objective is to estimate the vastus medialis (VM) muscle force from multifrequency magnetic resonance elastography (MMRE) tests and two different rheological models (Voigt and springpot). Healthy participants (N = 13) underwent multifrequency (70, 90 and 110 Hz) magnetic resonance elastography MMRE tests. Thus, in vivo experimental elastic (μ) properties of the VM in passive and active (20% MVC) conditions were characterized. Moreover, the muscle viscosity (η) was determined with Voigt and springpot rheological models, in both muscle states. Subsequently, the VM muscle forces were calculated with a generic musculoskeletal model (OpenSIM) where the active and passive shear moduli (μ) were implemented. The viscosity measured with the two rheological models increased when the muscle is contracted. During the stance and the swing phases, the VM tensile forces decrease and the VM force was lower with the springpot model. It can be noted that during the swing phase, the muscle forces estimated from springpot model showed a higher standard deviation compared to the Voigt model. This last result may indicate a strong sensitivity of the muscle force to the change of active and passive contractile components in the swing phase of gait. This study provides for the first time an estimation of the muscle tensile forces for lower limb, during human motion, from in vivo experimental muscle mechanical properties. The assessment of individualized muscle forces during motion is valuable for finite element models, increasing the patient specific parameters. This novel muscle database will be of use for the clinician to better elucidate the muscle pathophysiology and to better monitor the effects of the muscle disease.

Identification process based on shear wave propagation within a phantom using finite element modelling and magnetic resonance elastography

Magnetic resonance elastography (MRE), based on shear wave propagation generated by a specific driver, is a non-invasive exam performed in clinical practice to improve the liver diagnosis. The purpose was to develop a finite element (FE) identification method for the mechanical characterisation of phantom mimicking soft tissues investigated with MRE technique. Thus, a 3D FE phantom model, composed of the realistic MRE liver boundary conditions, was developed to simulate the shear wave propagation with the software ABAQUS. The assumptions of homogeneity and elasticity were applied to the FE phantom model. Different ranges of mesh size, density and Poisson's ratio were tested in order to develop the most representative FE phantom model. The simulated wave displacement was visualised with a dynamic implicit analysis. Subsequently, an identification process was performed with a cost function and an optimisation loop provided the optimal elastic properties of the phantom. The present identification process was validated on a phantom model, and the perspective will be to apply this method on abdominal tissues for the set-up of new clinical MRE protocols that could be applied for the follow-up of the effects of treatments.

IN VIVOCHARACTERIZATION OF THE MUSCLE VISCOELASTICITY IN PASSIVE AND ACTIVE CONDITIONS USING MULTIFREQUENCY MR ELASTOGRAPHY

This study aims to develop a viscoelastic database for muscles (VM: vastus medialis and Sr: sartorius) and subcutaneous adipose tissue with multifrequency magnetic resonance elastography (MMRE) coupled with rheological models. MMRE was performed on 13 subjects, at 70-90-110 Hz, to experimentally assess the elastic properties (μ) of passive and active (20% MVC) muscles. Then, numerical shear modulus (μ) and viscosity (η) were calculated using three rheological models (Voigt, Zener, Springpot). The elastic properties, obtained with the Springpot model, were closer to the experimental data for the different physiological tissues (μSpringpot_VM_Passive= 3.67 ± 0.71 kPa, μSpringpot_Sr= 6.89 ± 1.27 kPa, μSpringpot_Adipose Tissue= 1.61 ± 0.37 kPa) and at different muscle states (μSpringpot_VM_20%MVC= 11.29 ± 1.04 kPa). The viscosity parameter increased with the level of contraction (η_VM_ Passive_Springpot= 4.5 ± 1.64 Pa.s versus η_VM_20% MVC_Springpot= 12.14 ± 1.47 Pa.s ) and varied with the type of muscle. (η_VM_ Passive_Springpot= 4.5 ± 1.64 Pa.s versus η_Sr_Springpot= 6.63 ± 1.27 Pa.s). Similar viscosities were calculated for all tissues and rheological models. These first physiologically realistic viscoelastic parameters could be used by the physicians to better identify and monitor the effects of muscle disorder, and as a database for musculoskeletal model.

A possible clinical tool to depict muscle elasticity mapping using magnetic resonance elastography

INTRODUCTION

Characterization of muscle elasticity will improve the diagnosis and treatment of muscle disorders. The purpose is to compare the use of magnetic resonance elastography (MRE) and ultrasound elastography (USE) techniques to elucidate the MRE cartography of thigh muscles.

METHODS

Both elastography techniques were performed on 5 children and 7 adults. Quantitative (MRE) and qualitative (USE) cartographies of muscle elasticity, as a function of muscle state and age, were obtained with shear waves and manual compression of the ultrasound probe, respectively.

RESULTS

Similar cartographies of muscle elasticity were obtained with the 2 methods. The combination of both imaging techniques results in an improved depiction of the physiological changes associated with muscle state and age.

CONCLUSIONS

This study demonstrates the feasibility of MRE for use as a clinical tool in the characterization of neuromuscular pathologies and for assessing the efficacy of specific treatments for muscle related diseases.

Cutoff values for alcoholic liver fibrosis using magnetic resonance elastography technique

BACKGROUND

Due to the lack of cutoff values validated for specific liver diseases, the purpose of this study was to set up specific magnetic resonance elastography (MRE) cutoff values for asymptomatic liver fibrosis in alcoholic patients.

METHODS

Ninety patients underwent 3 clinical exams. The liver stiffness was measured locally with the Fibroscan, and globally through cartographies of shear modulus generated with MRE. The Fibroscan method was chosen as the gold standard to classify the fibrosis. The liver score was also obtained with the Fibrometer A, and the diagnostic performance of the methods was analyzed with receiver-operating characteristic (ROC) curves and cutoff values were calculated.

RESULTS

Spearman correlation and area under the ROC curve revealed that MRE is a better diagnostic method than the Fibrometer A, to identify various levels of fibrosis. The results showed that the Fibrometer A was adapted for severe fibrosis. The MRE cutoff values are F1:2.20 kPa, F2:2.57 kPa, F3:3.31 kPa, and F4:4 kPa and were not influenced by the glutamic oxaloacetic transaminase level. By using the ultrasound cutoff values attributed for alcoholism, 66% of patients had a similar liver fibrosis diagnosis as the MRE cutoffs. However, both imaging techniques did not provide the same distribution for minor fibrosis.

CONCLUSIONS

None of the imaging techniques (Fibroscan, MRE) could replace the gold standard of the biopsy. However, due to the risk and the unnecessary procedure for the present recruited alcoholic patients, the Fibroscan method was chosen as the reference. Since MRE is currently being used as a clinical exam, the present MRE cutoffs could aid clinicians with their diagnosis of liver fibrosis for alcoholism disease.

Characterization of a hyper-viscoelastic phantom mimicking biological soft tissue using an abdominal pneumatic driver with magnetic resonance elastography (MRE)

The purpose of this study was to create a polymer phantom mimicking the mechanical properties of soft tissues using experimental tests and rheological models. Multifrequency Magnetic Resonance Elastography (MMRE) tests were performed on the present phantom with a pneumatic driver to characterize the viscoelastic (μ, η) properties using Voigt, Maxwell, Zener and Springpot models. To optimize the MMRE protocol, the driver behavior was analyzed with a vibrometer. Moreover, the hyperelastic properties of the phantom were determined using compressive tests and Mooney-Rivlin model. The range of frequency to be used with the round driver was found between 60 Hz and 100 Hz as it exhibits one type of vibration mode for the membrane. MRE analysis revealed an increase in the shear modulus with frequency reflecting the viscoelastic properties of the phantom showing similar characteristic of soft tissues. Rheological results demonstrated that Springpot model better revealed the viscoelastic properties (μ=3.45 kPa, η=6.17 Pas) of the phantom and the Mooney-Rivlin coefficients were C(10)=1.09.10(-2) MPa and C(01)=-8.96.10(-3) MPa corresponding to μ=3.95 kPa. These studies suggest that the phantom, mimicking soft tissue, could be used for preliminary MRE tests to identify the optimal parameters necessary for in vivo investigations. Further developments of the phantom may allow clinicians to more accurately mimic healthy and pathological soft tissues using MRE.

Stiffness imaging of the kidney and adjacent abdominal tissues measured simultaneously using magnetic resonance elastography

To date, non-invasive methods to detect kidney malignancies and mild tumors remain a challenge. The purpose of this study was to establish the proper imaging protocol to determine kidney stiffness and its spatial distribution within the various kidney compartments such as the renal sinus, medulla, and cortex. Here, we have used magnetic resonance elastography (MRE) along with coronal oblique acquisition to simultaneously measure kidney stiffness in comparison with other tissues including the liver, spleen, and psoas.

TIEG1-NULL OSTEOCYTES DISPLAY DEFECTS IN THEIR MORPHOLOGY, DENSITY AND SURROUNDING BONE MATRIX

Through the development of TGFβ-inducible early gene-1 (TIEG1) knockout (KO) mice, we have demonstrated that TIEG1 plays an important role in osteoblast-mediated bone mineralization, and in bone resistance to mechanical strain. To further investigate the influence of TIEG1 in skeletal maintenance, osteocytes were analyzed by transmission electron microscopy using TIEG1 KO and wild-type mouse femurs at one, three and eight months of age. The results revealed an age-dependent change in osteocyte surface and density, suggesting a role for TIEG1 in osteocyte development. Moreover, there was a decrease in the amount of hypomineralized bone matrix surrounding the osteocytes in TIEG1 KO mice relative to wild-type controls. While little is known about the function or importance of this hypomineralized bone matrix immediately adjacent to osteocytes, this study reveals significant differences in this bone microenvironment and suggests that osteocyte function may be compromised in the absence of TIEG1 expression.

Analysis of thigh muscle stiffness from childhood to adulthood using magnetic resonance elastography (MRE) technique

BACKGROUND

Magnetic resonance elastography has been performed in healthy and pathological muscles in order to provide clinicians with quantitative muscle stiffness data. However, there is a lack of data on pediatric muscle. Therefore, the present work studies age-related changes of the mechanical properties.

METHODS

26 healthy subjects composed of 7 children (8-12 years), 9 young adults (24-29 years) and 10 middle-aged adults (53-58 years) underwent a magnetic resonance elastography test. Shear modulus (μ) and its spatial distribution, as well as the attenuation coefficient (α) were measured on the vastus medialis muscle at rest and at contracted conditions (10% and 20% of the maximum voluntary contraction) for each group.

FINDINGS

The shear modulus linearly increases with the degree of contraction for young adults while it is maximum at 10% of the maximum voluntary contraction for children (μ_(children_10%)=14.9kPa (SD 2.18)) and middle-aged adults (μ_(middle-aged_10%)=10.42kPa (SD 1.38)). Mapping of shear modulus revealed a diffuse distribution of colors reflecting differences in muscle physiological activity as a function of age. The attenuation coefficient showed a similar behavior for all groups, i.e. a decrease from the relaxed to the contracted states.

INTERPRETATION

This study demonstrates that the magnetic resonance elastography technique is sensitive enough to detect changes in muscle mechanical properties for children, middle-aged and young adults and could provide clinicians with a muscle reference data base as a function of age, improving the diagnosis of muscular dystrophy.

TIEG1-null tenocytes display age-dependent differences in their gene expression, adhesion, spreading and proliferation properties

The remodeling of extracellular matrix is a crucial mechanism in tendon development and the proliferation of fibroblasts is a key factor in this process. The purpose of this study was to further elucidate the role of TIEG1 in mediating important tenocyte properties throughout the aging process. Wildtype and TIEG1 knockout tenocytes adhesion, spreading and proliferation were characterized on different substrates (fibronectin, collagen type I, gelatin and laminin) and the expression levels of various genes known to be involved with tendon development were analyzed by RT-PCR. The experiments revealed age-dependent and substrate-dependent properties for both wildtype and TIEG1 knockout tenocytes. Taken together, our results indicate an important role for TIEG1 in regulating tenocytes adhesion, spreading, and proliferation throughout the aging process. Understanding the basic mechanisms of TIEG1 in tenocytes may provide valuable information for treating multiple tendon disorders.

Characterization of muscle architecture in children and adults using magnetic resonance elastography and ultrasound techniques

The purpose of this study is to characterize the muscle architecture of children and adults using magnetic resonance elastography and ultrasound techniques. Five children (8-12 yr) and seven adults (24-58 yr) underwent both tests on the vastus medialis muscle at relaxed and contracted (10% and 20% of MVC) states. Longitudinal ultrasonic images were performed in the same area as the phase image showing the shear wave's propagation. Two geometrical parameters were defined: the wave angle (α(_MRE)) corresponding to the shear wave propagation and the fascicule angle (α(_US)) tracking the path of fascicles. Moreover, shear modulus was measured at different localizations within the muscle and in the subcutaneous adipose tissue. The association of both techniques demonstrates that the shear wave propagation follows the muscle fascicles path, reflecting the internal muscle architecture. At rest, ultrasound images revealed waves propagating parallel to the children fascicle while adults showed oblique waves corresponding to already oriented (α(_US)=15.4±2.54°) muscle fascicles. In contraction, the waves' propagation were in an oblique direction for children (α(_US_10%MVC)=10.6±2.27°, α(_US_20%MVC)=10.2±2.29°) as well as adults (α(_US_10%MVC)=15.4±2.54°, α(_US_20%MVC)=17.2±2.44°). A stiffness variation (1 kPa) was found between the upper and lower parts of the adult VM muscle and a lower stiffness (1.85±0.17 kPa) was measured in the subcutaneous adipose tissue. This study demonstrates the feasibility of the MRE technique to provide geometrical insights from the children and adults muscles and to characterize different physiological media.

Molecular structure of tail tendon fibers in TIEG1 knockout mice using synchrotron diffraction technology

The purpose of this study was to characterize the effect of TIEG1 on the molecular structure of collagen within tail tendon fibers using 3-mo-old female C57BL/6 wild-type (WT) and TIEG1 KO mice. Synchrotron X-ray microdiffraction experiments were carried out on single tendon fibers extracted from the WT and TIEG1 KO dorsal tail tendon. The fibers were scanned in the radial direction, and X-ray patterns were obtained. From these patterns, the meridional direction was analyzed through X-ray intensity profile. In addition, collagen content was investigated using hydroxyproline assays, and qualitative real-time PCR experiments were performed on RNA isolated from fibroblasts to examine specific gene expression changes. The results showed different X-ray diffraction patterns between WT and TIEG1 KO tendon fibers, indicating a disorganization of the collagen structure for the TIEG1 KO compared with WT mice. Furthermore, the analyses of the X-ray intensity profiles exhibited a higher (23 A) period of collagen for the TIEG1 KO compared with the WT mice. The results of the hydroxyproline assays revealed a significant decrease in the TIEG1 KO compared with WT mice, leading to a decrease in the total amount of collagen present within the TIEG1 KO tendons. Moreover, qualitative real-time PCR results showed differences in the expression profiles of specific genes known to play important roles in tendon fiber development. These data further elucidate the role of TIEG1 on tendon structure and could explain the previous defects in the structure-function relationship found for TIEG1 KO tendon fibers.

Accelerated Achilles tendon healing by PDGF gene delivery with mesoporous silica nanoparticles

We report the ability of amino- and carboxyl-modified MCM-41 mesoporous silica nanoparticles (MSN) to deliver gene in vivo in rat Achilles tendons, despite their inefficiency to transfect primary tenocytes in culture. We show that luciferase activity lasted for at least 2 weeks in tendons injected with these MSN and a plasmid DNA (pDNA) encoding the luciferase reporter gene. By contrast, in tendons injected with naked plasmid, the luciferase expression decreased as a function of time and became hardly detectable after 2 weeks. Interestingly, there were neither signs of inflammation nor necrosis in tendon, kidney, heart and liver of rat weekly injected with pDNA/MSN formulation during 1.5 months. Our main data concern the acceleration of Achilles tendons healing by PDGF-B gene transfer using MSN. Biomechanical properties and histological analyses clearly indicate that tendons treated with MSN and PDGF gene healed significantly faster than untreated tendons and those treated with pPDGF alone.

Measurement of liver stiffness with two imaging techniques: magnetic resonance elastography and ultrasound elastometry

PURPOSE

To cross-validate the magnetic resonance elastography (MRE) technique with a clinical device, based on an ultrasound elastometry system called Fibroscan.

MATERIALS AND METHODS

Ten healthy subjects underwent an MRE and a Fibroscan test. The MRE technique used a round pneumatic driver at 60 Hz to generate shear waves inside the liver. An elastogram representing a map of the liver stiffness was generated allowing for the measurement of the average liver stiffness inside a region of interest. The Fibroscan technique used an ultrasound probe (3.5 MHz) composed of a vibrator that sent low-frequency (50 Hz) shear waves inside the right liver lobe. The probe acts as an emitter-receptor that measures the velocity of the waves propagated inside the liver tissue.

RESULTS

The mean shear stiffness measured with the MRE and Fibroscan techniques were 1.95+/-0.06 kPa and 1.79+/-0.30 kPa, respectively. A higher standard deviation was found for the same subject with Fibroscan.

CONCLUSION

This study shows why MRE should be investigated beyond the Fibroscan. The MRE technique provided elasticity of the entire liver, meanwhile the Fibroscan provided values of elasticity locally.

Thigh muscle stiffness assessed with magnetic resonance elastography in hyperthyroid patients before and after medical treatment

PURPOSE

To measure the stiffness of the vastus medialis (VM) in hyperthyroid patients before and after treatment.

MATERIALS AND METHODS

A total of five healthy euthyroid patients and five hyperthyroid patients were tested using magnetic resonance elastography (MRE), which involves the induction of shear waves in the thigh muscles using a pneumatic driver at 90 Hz.

RESULTS

Among the pretreatment hyperthyroid cohort a lower stiffness was found when the muscle was relaxed (2.11 +/- 0.61 kPa) compared the stiffness following treatment of hyperthyroidism (5.52 +/- 1.52 kPa), which was accompanied by an improvement in the contractile function of the VM. Pretreatment muscle stiffness was also less than that of age matched healthy volunteers (4.56 +/- 0.40 kPa). The behavior of the waves was sensitive to the stage of this myopathy and to the amount of free thyroxine (FT4).

CONCLUSION

The MRE technique provides a new tool to gain new insights into pathophysiology of thyroid associated and other muscle diseases and their response to treatment.

Applications of magnetic resonance elastography to healthy and pathologic skeletal muscle

Magnetic resonance elastography (MRE) is capable of noninvasively quantifying the mechanical properties of skeletal muscles in vivo. This information can be clinically useful to understand the effects of pathologies on the mechanical properties of muscle and to quantify the effects of treatment. Advances in inversion algorithms quantify muscle anisotropy in two-dimensional (2D) and three-dimensional (3D) imaging. Databases of the shear stiffness of skeletal muscle have been presented in the relaxed and contracted states in the upper extremity (biceps brachii, flexor digitorum profundus, and upper trapezius), distal leg muscles (tibialis anterior, medial gastrocnemius, lateral gastrocnemius, and trapezius), and proximal leg muscles (vastus lateralis, vastus medialis, and sartorius). MRE measurements have successfully validated a mathematical model of skeletal muscle behavior in the biceps brachii, correlated to electromyographic data in the distal leg muscles and quantified the effects of pathologies on the distal and proximal leg muscles. Future research efforts should be directed toward improving one-dimensional (1D) and 3D MRE data acquisition and image processing, tracking the effects of treatment on pathologic muscle and correlating the shear stiffness with clinical measurements.

TGFbeta inducible early gene-1 knockout mice display defects in bone strength and microarchitecture

TGFbeta inducible early gene-1 (TIEG) is a member of the Sp/Krüppel-like transcription factor family originally cloned from human osteoblasts. We have previously demonstrated that TIEG plays a role in the expression of important osteoblast marker genes and in the maturation/differentiation of osteoblasts. To elucidate the function of TIEG in skeletal development and maintenance, we have generated a TIEG knockout (KO) mouse. Three-point bending tests demonstrated that the femurs of TIEG KO mice are significantly weaker than those of wild-type animals. pQCT analysis of tibias revealed significant decreases in bone content, density and size in KO animals compared to wild-type mice. Micro-CT analysis of the femoral head and vertebrae revealed increases in femoral head trabecular separation and decreases in cortical bone thickness and vertebral bone volume in KO mice relative to wild-type controls. In addition, electron microscopy indicated a significant decrease in osteocyte number in the femurs of KO mice. Taken together, these data demonstrate that the bones of TIEG KO mice display an osteopenic phenotype with significantly weaker bones and reduced amounts of cortical and trabecular bone. In summary, an important role for TIEG in skeletal development and/or homeostasis is indicated.

Age-dependent changes in the mechanical properties of tail tendons in TGF-β inducible early gene-1 knockout mice

The purpose of this study is to investigate age-dependent changes in the architecture and mechanical properties of tendon in TGF-β inducible early gene-1 (TIEG) knockout mice. Wild-type and TIEG knockout mice, aged 1, 2, and 15 mo, were used. The mechanical properties of tail tendons isolated from these mice were determined using uniaxial tensile ramp (0.05 mm/s) and relaxation (5 mm/s) tests, with a strain of 10%. Mechanical parameters (Young's modulus from the ramp test; fast and static stresses from the relaxation test) were measured and recorded. The structure of the tail tendon fascicle was characterized by transmission electron microscopy. The results of the mechanical testing revealed no significant difference between the knockout and wild-type groups at 1 or 15 mo of age. However, the fascicles of the knockout mice at 3 mo of age exhibited decreased fast and static stresses compared with those of the wild-type mice. Electron microscopy revealed an increase in fibril size in the knockout mouse tendons relative to wild-type controls at 1 and 3 mo of age. These data indicate an important role for TIEG in tendon microarchitecture and strength in adult mice.

Determination of thigh muscle stiffness using magnetic resonance elastography

PURPOSE

To measure the elastic properties of the vastus lateralis (VL), vastus medialis (VM), and sartorius (Sr) muscles using magnetic resonance elastography (MRE).

MATERIALS AND METHODS

To obtain a normative database of the aforementioned muscles, oblique scan directions were prescribed passing through each muscle. Shear waves were induced into the muscles using pneumatic and mechanical drivers at 90 and 120 Hz, respectively. These drivers were attached to the distal end of the right thigh with the knee flexed at 30 degrees . The foot was placed in a footplate containing MR-compatible load cells to record the force during a contraction (10% and 20% of the maximum voluntary contraction).

RESULTS

The shear moduli measured at rest in the VL (N = 12), VM (N = 14), and Sr (N = 13) were 3.73 +/- 0.85 kPa, 3.91 +/- 1.15 kPa, and 7.53 +/- 1.63 kPa, respectively. The stiffness of both vasti increased with the level of contraction, while the stiffness of the Sr remained the same.

CONCLUSION

The MRE technique was able to approximate the stiffness of different thigh muscles. Furthermore, the wave length was sensitive to the morphology (unipennate or longitudinal) and fiber composition (type I or II) in each muscle.